Aneurysm treatment device

ABSTRACT

An implant having an elongated portion and an expandable braided sack portion can be delivered through a catheter and implanted in an aneurysm such that elongated portion loops within the braided sack, the braided sack contacts a majority or all of the aneurysm wall, and the braided sack at least partially occludes the aneurysm neck.

CROSS REFERENCE TO RELATED APPLICATION

The present application is a continuation application of U.S. patentapplication Ser. No. 16/366,235 filed Mar. 27, 2019, the entire contentsof which are hereby incorporated by reference.

FIELD OF INVENTION

The present invention generally relates to medical instruments, and moreparticularly, to embolic implants for aneurysm therapy.

BACKGROUND

Cranial aneurysms can be complicated and difficult to treat due to theirproximity to critical brain tissues. Prior solutions have includedendovascular treatment whereby an internal volume of the aneurysm sac isremoved or excluded from arterial blood pressure and flow. Currentalternatives to endovascular or other surgical approaches can includeintravascularly delivered treatment devices that either fill the sac ofthe aneurysm with embolic material or block the entrance or neck of theaneurysm. Both approaches attempt to prevent blood flow into theaneurysm. When filling an aneurysm sac, the embolic material clots theblood, creating a thrombotic mass within the aneurysm. When treating theaneurysm neck, blood flow into the entrance of the aneurysm isinhibited, inducing venous stasis in the aneurysm and facilitating anatural formation of a thrombotic mass within the aneurysm.

Current intravascularly delivered devices typically utilize multipleembolic coils to either fill the sac or treat the entrance. Naturallyformed thrombotic masses formed by treating the entrance of the aneurysmwith embolic coils can improve healing compared to aneurysm massespacked with embolic coils by reducing possible distention from arterialwalls and permitting reintegration into the original parent vessel shapealong the neck plane. However, embolic coils delivered to the neck ofthe aneurysm can potentially have the adverse effect of impeding theflow of blood in the adjoining blood vessel; at the same time, if theentrance is insufficiently packed, blood flow can persist into theaneurysm. Treating certain aneurysm morphology (e.g. wide neck,bifurcation, etc.) can required ancillary devices such a stents orballoons to support the coil mass and obtain the desired packingdensity. Once implanted, the coils cannot easily be retracted orrepositioned. Furthermore, embolic coils do not always effectively treataneurysms as aneurysms treated with multiple coils often recanalize orcompact because of poor coiling, lack of coverage across the aneurysmneck, because of flow, or large aneurysm size.

Alternatives to embolic coils are being explored, for example a tubularbraided implant is disclosed in US Patent Publication Number20180242979, incorporated herein by reference. Tubular braided implantshave the potential to easily, accurately, and safely treat an aneurysmor other arterio-venous malformation in a parent vessel without blockingflow into perforator vessels communicating with the parent vessel.Compared to embolic coils, however, tubular braided implants are a newertechnology, and there is therefore capacity for improved geometries,configurations, delivery systems, etc. for the tubular braided implants.

There is therefore a need for improved methods, devices, and systems forimplants for aneurysm treatment.

SUMMARY

It is an object of the present invention to provide systems, devices,and methods to meet the above-stated needs. Generally, in examplesherein, an implant having an elongated portion and an expandable braidedsack portion can be delivered through a catheter and implanted in ananeurysm such that elongated portion loops within the braided sack andthe braided sack at least partially occludes the aneurysm neck.

An example implant can include an expandable braided sack portion, anelongated looping portion joined to the braided sack portion, and adetachment feature joined to the elongated looping portion. The implantcan move from a delivery configuration to an implanted configuration. Inthe delivery configuration, the implant can be sized to be deliveredthrough a lumen of a catheter to a treatment site, and in the implantedconfiguration, the implant can be sized to secure within an aneurysm. Inthe delivery configuration, the expandable braided sack portion canextend from a distal end of the implant, the elongated looping portioncan extend proximally from the expandable braided sack portion, thedetachment feature can be positioned near a proximal end of the implant,and the detachment feature can be detachably attached to a deliverysystem.

The expandable braided sack portion can be unattached to the deliverysystem when the implant is in the delivery configuration, in theimplanted configuration, and throughout the transition from the deliveryconfiguration to the implanted configuration during treatment of ananeurysm. In the implanted configuration, the expandable braided sackportion can be sized to contact a majority of an interior wall of theaneurysm, can contain the elongated looping portion, and can occludesome or all of the opening of the neck of the aneurysm. The expandablebraided sack portion can have a free end, and in the implantedconfiguration, the free open end can be positioned at the aneurysm neck.In the implanted configuration the elongated looping portion can windwithin the expandable braided sack portion.

In the delivery configuration the implant can have a fold at its' distalend, the expandable braided sack portion can encompass some of theelongated looping portion, and the free open end of the expandablebraided sack portion can encircle the elongated looping portion. In theimplanted configuration, a fold can define a boundary between theelongated looping portion and the expandable braided sack portion, andthe fold can be positioned along a distal surface of the interioraneurysm wall. the fold at the distal end of the implant in the deliveryconfiguration can be the same fold positioned along the distal surfaceof the aneurysm wall in the implanted configuration.

Alternatively, in the delivery configuration, the free open end can bepositioned at the distal end of the implant and the implant can extendfrom the free open end at the distal end of the implant to thedetachment feature at the proximal end of the implant. When the implantconfigured thusly, exits a catheter and the braided sack portion entersthe aneurysm, a fold can form, and the fold can be positioned along adistal surface of the interior aneurysm wall.

The elongated looping portion and the expandable braided sack portioncan be portions of a contiguous tubular braid. A fold can define aboundary between the elongated looping portion and the expandablebraided sack portion, and the elongated looping portion can have alength measurable from the fold to the detachment feature. The elongatedlooping portion of the contiguous tubular braid can have a substantiallyuniform circumference along most of its length

Alternatively, the elongated looping portion can have an embolic coiland the expandable braided sack portion can be a tubular braid.

When the implant is implanted and left in an aneurysm at the completionof an aneurysm treatment, the implant can include only the sack portion,the elongated looping portion, and the detachment feature. The implantneed not have any other features such as additional detachment featuresor anchoring elements.

An example method of treating an aneurysm can include one or more of thefollowing steps presented in no particular order, and the method caninclude additional steps not included here. An implant having anexpandable portion and an embolic coiling portion can be provided. Theembolic coiling portion can be detachably attached to a delivery system.The implant can be positioned within a microcatheter such that theembolic coiling portion extends distally from a proximal end of theimplant, the expandable portion extends proximally from the distal endof the implant, and the expandable portion is unattached to the deliverysystem. The distal end of the microcatheter can be positioned near theaneurysm neck. The implant can be delivered through the microcatheter tothe distal end of the microcatheter. The expandable portion can beexpelled from the distal end of the microcatheter. The expandableportion can be expanded to contact a majority of the interior wall ofthe aneurysm. The embolic coiling portion can be expelled from thedistal end of the microcatheter. The embolic coiling portion can beplaced to wind within the expanded expandable portion. The emboliccoiling portion can be detached from the delivery system.

When the implant is positioned in a microcatheter, a fold can bepositioned at the distal end of the implant and the expandable portioncan be positioned to encompass at least a portion of the embolic coilingportion. Alternatively, when the implant is positioned in amicrocatheter, a free open end of the implant can be positioned at thedistal end of the implant.

The expandable portion can be anchored to the interior wall of theaneurysm, and the expandable portion can be placed to inhibit theembolic coiling portion from exiting a sac of the aneurysm. Theexpandable portion can have a free open end, and the free open end canbe positioned at the aneurysm neck. The implant can be folded to createa fold that defines a boundary between the expandable portion and theembolic coiling portion. The fold can be positioned near a distalsurface of the interior aneurysm wall.

When the implant having the expandable portion and the embolic portionis provided, a contiguous tubular braid can be provided, and theexpandable portion and the embolic portion can be portions of thecontiguous tubular braid. When the embolic coiling portion of thecontiguous braid is placed to wind within the expanded expandableportion, a substantially uniform circumference can be maintained alongmost of the length of the embolic coiling portion. Alternatively, whenthe implant having the expandable portion and the embolic portion isprovided, a tubular braid joined an embolic coil can be provided suchthat the tubular braid includes the expandable portion and the emboliccoil includes the embolic portion.

A detachment feature can be provided and affixed to the embolic coilingportion. The detachment feature can be detachably attached to thedelivery system. To implant the expandable portion, embolic coilingportion, and the detachment feature in the aneurysm, the detachmentfeature can be detached from the delivery system. When the detachmentfeature is detached, only the expandable portion, embolic coilingportion, and the detachment feature can remain implanted in the implant.

Another example method for treating an aneurysm can include one or moreof the following steps presented in no particular order, and the methodcan include additional steps not included here. An implant can beprovided having a braided portion and an embolic portion. The braidedportion can include a memory shape material and can have a spherical orglobular predetermined shape. The embolic portion can be detachablyattached to an implant delivery system. The implant and the deliverysystem can be positioned within a lumen of a microcatheter. When theimplant and the delivery system is positioned in the microcatheter, thebraided portion can be collapsed to fit in the lumen and positioned inthe lumen to extend proximally from the distal end of the implant, theembolic portion can be positioned to extend distally from the proximalend of the implant, and the delivery system can be positioned to extendproximally from the embolic portion. The implant and the delivery systemcan traverse through the lumen of the microcatheter while the braidedportion is unattached to the delivery system. The implant can beexpelled from the microcatheter. When the implant is expelled, thebraided portion can be expelled from the microcatheter and expanded toform a sack shape based on the spherical predetermined shape, theembolic portion can be expelled from the microcatheter and coiled withinthe sack shape of the braided portion. When the implant is expelled, anopening can be positioned in the sack shape of the braided portion canbe positioned near the aneurysm neck, a fold can be positioned to definea boundary between the braided portion and the embolic portion near adistal surface of the aneurysm wall, and the embolic portion cantraverse through the opening in the sack shape.

BRIEF DESCRIPTION OF THE DRAWINGS

The above and further aspects of this invention are further discussedwith reference to the following description in conjunction with theaccompanying drawings, in which like numerals indicate like structuralelements and features in various figures. The drawings are notnecessarily to scale, emphasis instead being placed upon illustratingprinciples of the invention. The figures depict one or moreimplementations of the inventive devices, by way of example only, not byway of limitation.

FIGS. 1A through 1C are illustrations of an example implant in acollapsed or delivery configuration (FIG. 1A), a cross section of thecollapsed implant of FIG. 1A (FIG. 1C), and the example implant in animplanted or expanded configuration (FIG. 1B) according to aspects ofthe present invention;

FIGS. 2A through 2E are illustrations of an example implant duringimplantation steps according to aspects of the present invention;

FIGS. 3A and 3B are illustrations of an example implant in a collapsedor delivery configuration (FIG. 3A) and in an implanted or expandedconfiguration (FIG. 3B) according to aspects of the present invention;

FIGS. 4A and 4B are illustrations of an example implant in a collapsedor delivery configuration (FIG. 4A) and in an implanted or expandedconfiguration (FIG. 4B) according to aspects of the present invention;

FIGS. 5A through 5E are illustrations of an example implant duringimplantation steps according to aspects of the present invention;

FIGS. 6A and 6B are illustrations of an example implant in a collapsedor delivery configuration (FIG. 6A) and in an implanted or expandedconfiguration (FIG. 6B) according to aspects of the present invention;and

FIGS. 7 through 10 are flow diagrams outlining example method steps fortreating an aneurysm according to aspects of the present invention.

DETAILED DESCRIPTION

As object of the present invention is to provide an embolic implantsuitable for endovascular treatment of an aneurysm in a patient. Theimplant can have two parts that can reshape upon delivery to a treatmentsite.

FIG. 1A illustrates an example implant 200 in a collapsed or deliveryconfiguration. In the delivery configuration, the implant 200 can besized to be delivered to a treatment site through a catheter inserted invasculature of a patient. FIG. 1C illustrates a cross sectional view ofthe collapsed implant 200 as indicated in FIG. 1A. FIG. 1B illustratesthe example implant 200 illustrated in FIG. 1A in an expanded orimplanted configuration. In the implanted configuration, the implant 200can be positioned in a sac 12 of an aneurysm 10 to divert blood flowfrom a neck 16 of the aneurysm 10 and fill the sac 12 with embolicmaterial. The embolic material in the aneurysm sac 12 can promote theformation of a thrombotic mass in the aneurysm 10, and the diversion ofblood flow from the aneurysm neck 16 can induce venous stasis in theaneurysm and reduce the likelihood that the aneurysm recanalizes afteran aneurysm treatment procedure.

Referring collectively to FIGS. 1A through 1C, the implant 100 caninclude an elongated portion 204, an expandable sack portion 202, and adetachment feature 230. The elongated portion 204 and the expandablesack portion 202 can each be braided. The expandable sack portion 202and elongated portion 204 can be manufactured as two separate structuresor as a contiguous braided structure. Braided portions can be made frombraided Nitinol, cobalt, chromium, plastic, or other suitable material.Portions of the implant 200 can be made from a memory shape materialhaving a predetermined shape and a deformed shape. The memory shapematerial can be in the deformed shape when the implant 200 is in thedelivery configuration and can move toward the predetermined shape whenthe implant 200 is in the expanded or implanted configuration. Whenimplanted, the memory shape material can be restricted by anatomicalgeometries and the memory shape material can take a shape thatapproaches the predetermined shape but does not match the predeterminedshape due to the anatomical restrictions.

The detachment feature 230 can be joined to the elongated portion 204,and the detachment feature 230 can be detachably attached to a deliverysystem when the implant 200 is delivered through a catheter to atreatment site.

Referring to FIG. 1A, in the delivery configuration, the detachmentfeature 230 can be positioned at the proximal end 212 of the implant200, the elongated portion 204 can extend distally from the detachmentfeature 230 to a fold 203 positioned at a distal end 214 of the implant200, and the expandable braided sack portion 202 can extend proximallyfrom the fold 203. In the delivery configuration, the expandable braidedsack portion 202 can extend distally from the fold 203 to wrap around apart of the length L of the elongated portion 204, and the expandablebraided sack portion 202 can have an open end 226 that circles theelongated portion 204. The open end 226 is preferably simply the openend of a braid without any ancillary attachments. The open end 226 neednot be attached to a delivery system as the implant 200 is deliveredthrough a catheter to the treatment site or as the implant 200 isdeployed within the aneurysm. Strands of the braid 210 at the open end226 can be free, cut ends; or, alternatively, the strands at the openend 226 be closed, meaning strands within the braid at the open end areattached to each other by glue, weld, etc. or the strands bend back atthe open end. Free cut ends can have an advantage of being easier tomanufacture while the closed ends can have an advantage of being moreatraumatic compared to the cut ends.

Referring to FIGS. 1A and 1B, the implant 200 can include memory shapematerial and can be pre-shaped such that the expandable braided sackportion 202 forms a globular or spherical shape and a fold 203 separatesthe elongated looping portion 204 from the expandable braided sackportion 202. The memory shape material can be heat set into thepredetermined shape. The spherical shape, fold 203, and the loops of theelongated portion can be shaped by heat setting. The implanted shapeillustrated in FIG. 1B can be based on the predetermined shape and theshape of the interior wall 14 of the aneurysm 10. To collapse theimplant from the predetermined shape so that it can be delivered througha catheter, the elongated looping portion 204 can be extended andstraightened and the sack portion 202 can be compressed around theelongated looping portion 204. The fold created when the implant waspre-shaped can be further folded to define a boundary between the sackportion 202 and the elongated looping portion 204 when the implant 200is in the delivery configuration.

Referring to FIG. 1B, in the implanted configuration, the expandablebraided sack portion 202 can expand to contact a majority of theinterior wall 14 of the aneurysm 10. The fold 203 can be positioned neara distal surface 15 of the aneurysm wall 14. The elongated portion 204can wind within the aneurysm sac 12 and within the braided sack portion202. By anchoring within the sac 12, the expandable braided sack portion202 can maintain proper positioning of the implant 200 in the aneurysm10 and prevent portions of the implant 200, such as the elongatedportion 204, from extending into a blood vessel 20 a, 20 b, 21 orexiting the aneurysm sac 12.

The free open end 226 of the expandable braided sack portion 202 candefine an opening in the sack when the implant is in the implanted orpre-shaped configuration, and when implanted, the opening can bepositioned near the aneurysm neck 16. The opening can be sized such thata portion of the expandable braided sack portion 202 extends across theaneurysm neck 16 to occlude the neck. The elongated portion 204 canenter the aneurysm sac 12 and the sack of the expandable braided sackportion 202 through the opening. The elongated portion 204 can wind orloop around in a complex coiled shape within the expandable braided sackportion 202 and within the aneurysm sac 12. The looped elongated portion204 can press against the braided sack 202 and provide a force againstan interior surface of the braided sack 202 to press an exterior surfaceof the braided sack 202 to the aneurysm wall 14 to further secure theanchoring of the braided sack 202 within the aneurysm sac 12.

The looped elongated portion 204 can fill a majority of the aneurysm sac12. The implanted braided sack 202 can be a braided mesh with a porositysized to inhibit blood flow into the aneurysm 10. The elongated portioncan have a substantially uniform circumference 206 along much or all ofits length L, and it can maintain the substantially uniformcircumference 206 as it moves from the delivery configuration to theimplanted configuration.

FIGS. 2A through 2E are illustrations of an example implant duringimplantation steps. FIG. 2A illustrates an implant 200 positioned withina catheter 600 near an aneurysm 10. The aneurysm 10 is illustratedpositioned at a bifurcated blood vessel having a stem vessel 21, a firstside branch vessel 20 a, and a second side blood vessel 20 b. Thecatheter 600 can approach the aneurysm 10 from the stem vessel 21. It iscontemplated that example implants 200 disclosed herein can be used fortreating sidewall vessels according to methods described herein and aswould be understood by a person of ordinary skill in the art. At theinstant illustrated in FIG. 2A, the implant 200 is collapsed in thecatheter 600. The implant 200 can include memory shape material that isin a deformed shape while it is collapsed in the catheter 600.

FIG. 2B illustrates the implant 200 during implantation. The implant 200can include an expandable braided sack portion 202 and an elongatedembolic portion 204. As the implant 200 is translated distally throughthe catheter 600, a fold 203 can be positioned at a distal end 214 ofthe implant 200, and the expandable braided sack portion 202 and theelongated looping portion 204 can extend proximally from the fold 203.Configured thusly, the braided sack portion 202 can be oriented in thecatheter 600 so that when the implant 200 is pushed distally out of thecatheter 600, the braided sack portion 202 is pushed out of the catheter600 and into the sac 12 before a majority of the elongated loopingportion 204 is begins to exit the catheter 600.

FIG. 2C illustrates the implant 200 after the braided sack portion 202has exited the catheter 600 and expanded within the aneurysm 12. Thebraided sack portion 202 can expand to contact all or a majority of theinterior wall 14 of the aneurysm 10. The braided sack 202 can expandtoward the predetermined shape upon exiting the catheter 600. Contactwith warm bodily fluid can cause the memory shape material in thebraided sack 202 to move to the predetermined shape. The free open end226 can define an opening in the braided sack 202, and the opening canbe positioned at the aneurysm neck 16.

A fold 203 defining a boundary between the expanded braided sack 202 andthe elongated portion 204 can be positioned near a distal surface 15 ofthe aneurysm wall 14. At the stage of implantation illustrated in FIG.2C, the elongated portion 204 can extend from the fold 203, through theopening in the braided sack 202, and into the catheter 600.

FIG. 2D illustrates the elongated portion 204 exiting the catheter 600,entering the braided sack portion 202 through the free open end 226, andwinding within the sack 202. As the elongated portion 204 exits thecatheter 600, the elongated portion 204 can maintain its circumference206 as it exits the catheter 600. The elongated portion 204 can wind orloop within the aneurysm sac 12 in response to contacting an interiorsurface of the expanded braided sack 202. Additionally, oralternatively, the elongated portion 204 can include memory shapematerial having a predetermined shape and a deformed shape. Thepredetermined shape can be a complex looped shape, and the deformedshape can be substantially straight. The elongated portion 204 can windor loop within the aneurysm sac 12 in response to the memory shapematerial moving from the deformed shape toward the predetermined shapeas the elongated portion 204 contacts blood as it exits the catheter600. Additionally, or alternatively, the elongated portion 204 caninclude a flexible elastically deformable material having a relaxedshape that is a looped shape. The flexible elastically deformablematerial can be uncoiled to a substantially straight strand duringdelivery through a catheter and can collapse into the looped shape uponexiting the catheter 12.

At the instant illustrated in FIG. 2D the detachment feature 230 canremain attached to a delivery system. While the implant 200 is attachedto the delivery system, the delivery system can be pulled proximally towithdraw all or portions of the implant 200. The delivery system cansubsequently be pushed distally to reposition the implant 200.

FIG. 2E illustrates the implant 200 in a final implanted configurationsuch as described in relation to FIG. 1B. The detachment feature 230 canbe moved distally by the delivery system past the plane of the aneurysm16, through the open end 226 of the expanded sack portion 202, and intothe aneurysm sac 12 prior to detachment from the delivery system. Theelongated portion 204 can have a predetermined shape configured tofacilitate the movement of the detachment feature 230 past the plane ofthe aneurysm neck 16 once the implant 200 is implanted. Additionally, oralternatively, the delivery system can be manipulated to place thedetachment feature 230 within the sack portion 202. Once the implant 200is implanted as illustrated in FIG. 2E, the delivery system can bedetached and withdrawn, and the microcatheter 600 can be moved orextracted from the patient.

The open end 226 can remain open at the completion of the implantation,and the elongated portion 204, once secured within the sack 202, can becoiled near the opening defined by the open end 226 in such a way thatblood flow is obstructed from entering the opening. In other words, sack202 can occlude a portion of the neck 16 around the perimeter of theneck, and the elongated portion 204 can occlude the neck 16 at theopening in the sack 202 defined by the open end 226.

FIG. 3A illustrates an example implant 200 a in a collapsed or deliveryconfiguration. In the delivery configuration, the implant 200 a can becollapsed to a size that can be delivered to a treatment site through acatheter inserted in vasculature of a patient. FIG. 3B illustrates theexample implant 200 a illustrated in FIG. 3A in an expanded or implantedconfiguration. In the implanted configuration, the implant 200 a can bepositioned in a sac 12 of an aneurysm 10 to divert blood flow from aneck 16 of the aneurysm 10 and fill the sac 12 with embolic material.The embolic material in the aneurysm sac 12 can promote the formation ofa thrombotic mass in the aneurysm 10, and the diversion of blood flowfrom the aneurysm neck 16 can induce venous stasis in the aneurysm andreduce the likelihood that the aneurysm recanalizes after an aneurysmtreatment procedure.

Comparing the example implant 200 a illustrated in FIGS. 3A and 3B tothe implant 200 illustrated in FIGS. 1A through 2E, the elongatedportion 204 a of the implant 200 a in FIGS. 3A and 3B can be an emboliccoil 204 a rather than a braid 204 as illustrated in FIGS. 1A through2E. The implant 200 a illustrated in FIGS. 3A and 3B can be implantedfollowing a procedure like that illustrated in FIGS. 2A through 2E.

Referring collectively to FIGS. 3A and 3B, the implant 200 a can includethe embolic coil 204 a, an expandable braided sack portion 202 a, adetachment feature 230 a, and a connecting band 222 joining the emboliccoil 204 a to the expandable braid 202 a. The connecting band 222 caninclude radiopaque material to facilitate visibility of the implant 200a under X-ray. The expandable braided sack portion 202 a can be braided.Portions of the implant 200 a, including the embolic coil 204 a, can bemade from a memory shape material having a predetermined shape and adeformed shape. The memory shape material can be in the deformed shapewhen the implant 200 a is in the delivery configuration and can movetoward the predetermined shape when the implant 200 a is in the expandedor implanted configuration. When expanded or implanted, the memory shapematerial can be restricted by anatomical geometries and the memory shapematerial can take a shape that approaches the predetermined shape butdoes not match the predetermined shape due to the anatomicalrestrictions.

The detachment feature 230 a can be joined to the elongated portion 204a, and the detachment feature 230 a can be detachably attached to adelivery system when the implant 200 a is delivered through a catheterto a treatment site.

Referring to FIG. 3A, in the delivery configuration, the detachmentfeature 230 a can be positioned at the proximal end 212 a of the implant200 a, the elongated portion 204 can extend distally from the detachmentfeature 230 a to the connecting band 222, the braided portion 202 a canhave a fold 203 a positioned at a distal end 214 a of the implant 200 a,and the expandable braided sack portion 202 a can extend proximally fromthe fold 203 a. In the delivery configuration, the expandable braidedsack portion 202 a can extend distally from the fold 203 a to wraparound a part of the length L′ of the embolic coil 204 a, and theexpandable braided sack portion 202 a can have a free open end 226 athat circles the embolic coil 204 a. Strands of the braided portion 202a at the open end 226 a can be free, cut ends; or, alternatively, thestrands at the open end 226 a be closed, meaning strands within thebraid at the free open end 226 a are attached to each other by glue,weld, etc. or the strands bend back at the open end 226 a. Free cut endscan have an advantage of being easier to manufacture while the closedstrand ends can have an advantage of being more atraumatic compared tothe cut ends.

Referring to FIGS. 3A and 3B, the implant 200 a can include memory shapematerial and can be pre-shaped such that the expandable braided sackportion 202 a forms a globular or spherical shape and the braid can havea fold 203 a near the connecting band 222. The memory shape material canbe heat set into the predetermined shape. The implanted shapeillustrated in FIG. 3B can be based on the predetermined shape and theshape of the interior wall 14 of the aneurysm 10. To collapse theimplant from the predetermined shape so that it can be delivered througha catheter, the embolic coil 204 a can be extended and straightened andthe sack portion 202 a can be compressed around the elongated loopingportion 204 a. The fold created when the implant was pre-shaped can befurther folded and positioned at the distal end 214 a of the implant 200a when the implant 200 a is in the delivery configuration.

Referring to FIG. 3B, in the implanted configuration, the expandablebraided sack portion 202 a can expand to contact a majority of theinterior wall 14 of the aneurysm 10. The fold 203 a can be positionednear a distal surface 15 of the aneurysm wall 14. The embolic coil 204 acan wind within the aneurysm sac 12 and within the braided sack portion202 a. By anchoring within the sac 12, the expandable braided sackportion 202 a can maintain proper positioning of the implant 200 a inthe aneurysm 10 and prevent portions of the implant 200 a, such as theembolic coil 204 a, from extending into a blood vessel 20 a, 20 b, 21 orexiting the aneurysm sac 12.

The free end 226 a of the expandable braided sack portion 202 a candefine an opening in the sack when the implant 200 a is in the implantedor pre-shaped configuration, and when implanted, the opening can bepositioned near the aneurysm neck 16. The opening can be sized such thata portion of the expandable braided sack portion 202 a extends acrossthe aneurysm neck 16 to occlude the neck. The embolic coil 204 a canenter the aneurysm sac 12 and the sack of the expandable braided sackportion 202 a through the opening. The elongated portion 204 a can windor loop around in a complex coiled shape within the expandable braidedsack portion 202 a and within the aneurysm sac 12. The looped elongatedportion 204 a can press against the braided sack 202 a and provide aforce against an interior surface of the braided sack 202 a to press anexterior surface of the braided sack 202 a to the aneurysm wall 14 tofurther secure the anchoring of the braided sack 202 a within theaneurysm sac 12.

The looped embolic coil 204 a can fill a majority of the aneurysm sac12. The implanted braided sack 202 a can be a braided mesh with aporosity sized to inhibit blood flow into the aneurysm 10.

As an alternative to shaping the implant in the delivery configurationsuch that the expandable braided sack portion 202, 202 a envelopes theelongated portion 204, 204 a as illustrated in FIGS. 1A and 3A, theimplant can be elongated in the delivery configuration as illustrated inFIGS. 4A and 6A. The implant 200 illustrated in FIGS. 1A and 1B can havean essentially identical predetermined shape and/or implantedconfiguration compared to the implant 300 illustrated in FIGS. 4A and4B. Likewise, the implant 200 a illustrated in FIGS. 3A and 3B can havean essentially identical predetermined shape and/or implantedconfiguration compared to the implant 300 a illustrated in FIGS. 6A and6B.

Comparing FIGS. 1B and 4B, once implanted, the implants 200, 300 formedof a contiguous tubular braid 210, 310 can be indistinguishable.Likewise, comparing FIGS. 3B and 6B, once implanted, the implants 200 a,300 a formed of a braided portion 202 a, 302 a and an embolic coil 204a, 304 a can be indistinguishable. Significant difference between theimplants 200, 200 a illustrated in FIGS. 1A through 3B and the implants300, 300 a illustrated in FIGS. 4A through 6B include presence of thefold 203, 203 a or lack thereof in each respective deformed shape,position of the free open end 226, 226 a, 314, 314 a during delivery,and process of expanding the expandable braided portion 202, 202 a, 302,302 a within the aneurysm 10 during treatment.

Referring to FIGS. 4A and 4B, an implant 300 can include a contiguoustubular braid 310 and a detachment feature 330. As illustrated in FIG.4A, in the delivery configuration, the detachment feature 330 can bepositioned at the proximal end 312 of the implant 300, the elongatedportion 304 can extend distally from the detachment feature 330, theexpandable braided sack portion 302 can extend distally from theelongated portion 304, and the expandable braided sack portion 302 canhave a free open end positioned at the distal end 314 of the implant300. In the delivery configuration, the implant 300 need not have anydiscernable boundary to indicate which portion of the tubular braid 310is the elongated looping portion 304 and which portion is the expandablesack portion 302. Strands at the open end 314 can be free, cut ends; or,alternatively, the strands at the open end 314 be closed, meaningstrands within the braid at the free open end 314 are attached to eachother by glue, weld, etc. or the strands bend back at the open end 314.Free cut ends can have an advantage of being easier to manufacture whilethe closed strand ends can have an advantage of being more atraumaticcompared to the cut ends.

The implant 300 can include memory shape material and can be pre-shapedsuch that the expandable braided sack portion 302 forms a globular orspherical shape and a fold 303 separates the elongated looping portion304 from the expandable braided sack portion 302. The memory shapematerial can be heat set into the predetermined shape. The implantedshape illustrated in FIG. 4B can be based on the predetermined shape andthe shape of the interior wall 14 of the aneurysm 10. To collapse theimplant 300 from the predetermined shape (similar to the implantedconfiguration illustrated in FIG. 4B) to the deformed shape (such asillustrated in FIG. 4A) so that it can be delivered through a catheter,the elongated looping portion 304 can be extended and straightened, thesack portion 302 can be inverted and stretch, and the fold 303 can beopened and flattened.

Referring to FIG. 4B, in the implanted configuration, the expandablebraided sack portion 302 can expand to contact a majority of theinterior wall 14 of the aneurysm 10. The fold 303 can be positioned neara distal surface 15 of the aneurysm wall 14. The elongated portion 304can wind within the aneurysm sac 12 and within the braided sack portion302. By anchoring within the sac 12, the expandable braided sack portion302 can maintain proper positioning of the implant 300 in the aneurysm10 and prevent portions of the implant 300, such as the elongatedportion 304, from extending into a blood vessel 20 a, 20 b, 21 orexiting the aneurysm sac 12.

The free end 314 of the expandable braided sack portion 302 can definean opening in the sack when the implant is in the implanted orpre-shaped configuration, and when implanted, the opening can bepositioned near the aneurysm neck 16. The opening can be sized such thata portion of the expandable braided sack portion 302 extends across theaneurysm neck 16 to occlude the neck. The elongated portion 304 canenter the aneurysm sac 12 and the sack of the expandable braided sackportion 302 through the opening. The elongated portion 304 can wind orloop around in a complex coiled shape within the expandable braided sackportion 302 and within the aneurysm sac 12. The looped elongated portion304 can press against the braided sack 302 and provide a force againstan interior surface of the braided sack 302 to press an exterior surfaceof the braided sack 302 to the aneurysm wall 14 to further secure theanchoring of the braided sack 302 within the aneurysm sac 12.

The looped elongated portion 304 can fill a majority of the aneurysm sac12. The implanted braided sack 302 can be a braided mesh with a porositysized to inhibit blood flow into the aneurysm 10. The elongated portioncan have a substantially uniform circumference 306 along much or all ofits length, and it can maintain the substantially uniform circumference306 as it moves from the delivery configuration to the implantedconfiguration.

FIGS. 5A through 5E are illustrations of an example implant 300 duringimplantation steps. FIG. 5A illustrates an implant 300 positioned withina catheter 600 near an aneurysm 10. The aneurysm 10 is illustratedpositioned at a bifurcated blood vessel having a stem vessel 21, a firstside branch vessel 20 a, and a second side blood vessel 20 b. Thecatheter 600 can approach the aneurysm 10 from the stem vessel 21. It iscontemplated that example implants 300 disclosed herein can be used fortreating sidewall vessels according to methods described herein and aswould be understood by a person of ordinary skill in the art. At theinstant illustrated in FIG. 5A, the implant 300 is collapsed in thecatheter 600. The implant 300 can include memory shape material that isin a deformed shape while it is collapsed in the catheter 600.

FIG. 5B illustrates the implant 300 during implantation. The implant 300can include an expandable braided sack portion 302 and an elongatedembolic portion 304. As the implant 300 is translated distally throughthe catheter 600, the free open end 314 of the expandable braided sackportion 302 can be positioned at a distal end 314 of the implant 300,the expandable portion 302 can extend proximally from its free open end314, and the elongated embolic or looping portion 304 can extendproximally from the expandable portion 302. Configured thusly, theexpandable portion 302 can be completely expelled from the catheter 600before the elongated portion 304 begins to exit the catheter 600.

As illustrated in FIG. 5B, the expandable braided sack portion 302 canbegin to invert after exiting the catheter 600. The free open end 314can encircle the braid 310, and portions of the braid 310 can betranslated through the opening of the free open end 314. The free end314 of the implant 300 need not be attached to a delivery system for thebraided sack portion 302 to invert. The inversion can be a result of thebraided sack portion 302 moving toward its predetermined shape.

FIG. 5C illustrates the implant 300 after the braided sack portion 302has exited the catheter 600 and expanded within the aneurysm 12. Thebraided sack portion 302 can expand to contact all or a majority of theinterior wall 14 of the aneurysm 10. The braided sack 302 can expandtoward the predetermined shape upon exiting the catheter 600. Contactwith warm bodily fluid can cause the memory shape material in thebraided sack 302 to move to the predetermined shape. The free open end314 can define an opening in the braided sack 302, and the opening canbe positioned at the aneurysm neck 16.

A fold 303 defining a boundary between the expanded braided sack 302 andthe elongated portion 304 when in the implant 300 is in the implantedconfiguration can be positioned near a distal surface 15 of the aneurysmwall 14. At the stage of implantation illustrated in FIG. 5C, theelongated portion 304 can extend from the fold 303, through the openingin the braided sack 302, and into the catheter 600.

FIG. 5D illustrates the elongated portion 304 exiting the catheter 600,entering the braided sack portion 302 through the free open end 314, andwinding within the sack 302. As the elongated portion 304 exits thecatheter 600, the elongated portion 304 can maintain its circumference306 as it exits the catheter 600. The elongated portion 304 can wind orloop within the aneurysm sac 12 in response to contacting an interiorsurface of the expanded braided sack 302. Additionally, oralternatively, the elongated portion 304 can include memory shapematerial having a predetermined shape and a deformed shape. Thepredetermined shape can be a complex looped shape, and the deformedshape can be substantially straight. The elongated portion 304 can windor loop within the aneurysm sac 12 in response to the memory shapematerial moving from the deformed shape toward the predetermined shapeas the elongated portion 304 contacts blood as it exits the catheter600. Additionally, or alternatively, the elongated portion 304 caninclude a flexible elastically deformable material having a relaxedshape that is a looped shape. The flexible elastically deformablematerial can be uncoiled to a substantially straight strand duringdelivery through a catheter and can collapse into the looped shape uponexiting the catheter 12.

At the instant illustrated in FIG. 5D the detachment feature 330 canremain attached to a delivery system. While the implant 300 is attachedto the delivery system, the delivery system can be pulled proximally towithdraw all or portions of the implant 300. The delivery system cansubsequently be pushed distally to reposition the implant 300.

FIG. 5E illustrates the implant 300 in a final implanted configurationsuch as described in relation to FIG. 4B. The detachment feature 330 canbe moved distally by the delivery system past the plane of the aneurysm16, through the open end 314 of the expanded sack portion 302, and intothe aneurysm sac 12 prior to detachment from the delivery system. Theelongated portion 304 can have a predetermined shape configured tofacilitate the movement of the detachment feature 314 past the plane ofthe aneurysm neck 16 once the implant 300 is implanted. Additionally, oralternatively, the delivery system can be manipulated to place thedetachment feature 314 within the sack portion 302. Once the implant 300is implanted as illustrated in FIG. 5E, the delivery system can bedetached and withdrawn, and the microcatheter 600 can be moved orextracted from the patient.

The open end 314 can remain open at the completion of the implantation,and the elongated portion 304, once secured within the sack 302, can becoiled near the opening defined by the open end 314 in such a way thatblood flow is obstructed from entering the opening. In other words, sack302 can occlude a portion of the neck 16 around the perimeter of theneck, and the elongated portion 304 can occlude the neck 16 at theopening in the sack 302 defined by the open end 314.

FIG. 6A illustrates an example implant 300 a in a collapsed or deliveryconfiguration. In the delivery configuration, the implant 300 a can becollapsed to a size that can be delivered to a treatment site through acatheter inserted in vasculature of a patient. FIG. 6B illustrates theexample implant 300 a illustrated in FIG. 6A in an expanded or implantedconfiguration. In the implanted configuration, the implant 300 a can bepositioned in a sac 12 of an aneurysm 10 to divert blood flow from aneck 16 of the aneurysm 10 and fill the sac 12 with embolic material.The embolic material in the aneurysm sac 12 can promote the formation ofa thrombotic mass in the aneurysm 10, and the diversion of blood flowfrom the aneurysm neck 16 can induce venous stasis in the aneurysm andreduce the likelihood that the aneurysm recanalizes after an aneurysmtreatment procedure.

Comparing the example implant 300 a illustrated in FIGS. 6A and 6B tothe implant 300 illustrated in FIGS. 4A through 5E, the elongatedportion 304 a of the implant 300 a in FIGS. 6A and 6B can be an emboliccoil 304 a rather than a braid 304 as illustrated in FIGS. 4A through5E. The implant 300 a illustrated in FIGS. 6A and 6B can be implantedfollowing a procedure like that illustrated in FIGS. 5A through 5E.

Referring collectively to FIGS. 6A and 6B, the implant 300 a can includethe embolic coil 304 a, an expandable braided sack portion 302 a, adetachment feature 330 a, and a connecting band 322 joining the emboliccoil 304 a to the expandable braid 302 a. The expandable braided sackportion 302 a can be braided. Portions of the implant 300 a, includingthe embolic coil 304 a, can be made from a memory shape material havinga predetermined shape and a deformed shape. The memory shape materialcan be in the deformed shape when the implant 300 a is in the deliveryconfiguration and can move toward the predetermined shape when theimplant 300 a is in the expanded or implanted configuration. Whenexpanded or implanted, the memory shape material can be restricted byanatomical geometries and the memory shape material can take a shapethat approaches the predetermined shape but does not match thepredetermined shape due to the anatomical restrictions.

The detachment feature 330 a can be joined to the elongated portion 304a, and the detachment feature 330 a can be detachably attached to adelivery system when the implant 300 a is delivered through a catheterto a treatment site.

Referring to FIG. 6A, in the delivery configuration, the detachmentfeature 330 a can be positioned at the proximal end 312 a of the implant300 a, the elongated portion 304 can extend distally from the detachmentfeature 330 a to the connecting band 322, the braided portion 302 a canextend distally from the connecting band 322, and the braided portion302 a can have a free open end 314 a positioned at a distal end of theimplant 300 a. Strands of the braided portion 302 a at the open end 314a can be free, cut ends; or, alternatively, the strands at the open end314 a be closed, meaning strands within the braid at the free open end314 a are attached to each other by glue, weld, etc. or the strands bendback at the open end 314 a. Free cut ends can have an advantage of beingeasier to manufacture while the closed strand ends can have an advantageof being more atraumatic compared to the cut ends.

Referring to FIGS. 6A and 6B, the implant 300 a can include memory shapematerial and can be pre-shaped such that the expandable braided sackportion 302 a forms a globular or spherical shape and the braid can havea fold 303 a near the connecting band 322. The memory shape material canbe heat set into the predetermined shape. The implanted shapeillustrated in FIG. 6B can be based on the predetermined shape and theshape of the interior wall 14 of the aneurysm 10. To collapse theimplant from the predetermined shape so that it can be delivered througha catheter, the embolic coil 304 a can be extended and straightened, thesack portion 302 a can be inverted and stretched, and the fold 303 canbe opened and flattened.

Referring to FIG. 6B, in the implanted configuration, the expandablebraided sack portion 302 a can expand to contact a majority of theinterior wall 14 of the aneurysm 10. The fold 303 a can be positionednear a distal surface 15 of the aneurysm wall 14. The embolic coil 304 acan wind within the aneurysm sac 12 and within the braided sack portion302 a. By anchoring within the sac 12, the expandable braided sackportion 302 a can maintain proper positioning of the implant 300 a inthe aneurysm 10 and prevent portions of the implant 300 a, such as theembolic coil 304 a, from extending into a blood vessel 20 a, 20 b, 21 orexiting the aneurysm sac 12.

The free end 314 a of the expandable braided sack portion 302 a candefine an opening in the sack when the implant 300 a is in the implantedor pre-shaped configuration, and when implanted, the opening can bepositioned near the aneurysm neck 16. The opening can be sized such thata portion of the expandable braided sack portion 302 a extends acrossthe aneurysm neck 16 to occlude the neck. The embolic coil 304 a canenter the aneurysm sac 12 and the sack of the expandable braided sackportion 302 a through the opening. The elongated portion 304 a can windor loop around in a complex coiled shape within the expandable braidedsack portion 302 a and within the aneurysm sac 12. The looped elongatedportion 304 a can press against the braided sack 302 a and provide aforce against an interior surface of the braided sack 302 a to press anexterior surface of the braided sack 302 a to the aneurysm wall 14 tofurther secure the anchoring of the braided sack 302 a within theaneurysm sac 12.

The looped embolic coil 304 a can fill a majority of the aneurysm sac12. The implanted braided sack 302 a can be a braided mesh with aporosity sized to inhibit blood flow into the aneurysm 10.

FIG. 7 is a flow diagram outlining example method steps for treating ananeurysm. The method steps can be implemented by example devicespresented herein or by other means as would be known to one of ordinaryskill in the art.

Referring to method 700 outlined in FIG. 7, in step 702, an implanthaving an expandable portion and an embolic coiling portion can beprovided. In step 704, the embolic coiling portion can be detachablyattached to a delivery system. In step 706, the implant can bepositioned in a microcatheter with the embolic coiling portion extendingdistally from a proximal end of the implant, the expandable portionextending proximally form the distal end of the implant, and theexpandable portion being unattached to the delivery system. In step 708,the distal end of the microcatheter can be positioned near an aneurysmneck. In step 710, the implant can be delivered through themicrocatheter to the distal end of the microcatheter. In step 712, theexpandable portion can be expelled from the distal end of themicrocatheter. In step 714, the expandable portion can expand to contactmost of the interior wall of the aneurysm. In step 716, the emboliccoiling portion can be expelled from the distal end of themicrocatheter. In step 718, the embolic coiling portion can be placed towind within the expanded expandable portion. In step 720, the emboliccoiling portion can be detached from the delivery system.

Referring to method 800 outlined in FIG. 8, in step 810, an implanthaving an embolic portion and a braided portion having a memory shapematerial can be provided. In step 820, the braided portion can be shapedto have a spherical predetermined shape. In step 830, the embolicportion can be attached to an implant delivery system so that it canlater be detached. In step 840, the implant and the delivery system canbe positioned within a microcatheter. In step 850, the implant anddelivery system can traverse through the microcatheter while the braidedportion is unattached to the delivery system. In step 860, the implantcan be expelled from the microcatheter.

Step 840 in method 800, positioning the implant and the delivery systemin the microcatheter, can include sub steps as illustrated in FIG. 9. Insub step 842, the braided portion can be collapsed to fit within themicrocatheter. In sub step 844, the braided portion can be positioned toextend proximally from a distal end of the implant. In sub step 846, theembolic portion can be positioned to extend distally from a proximal endof the implant. In sub step 848, the delivery system can be positionedto extend proximally form the embolic portion.

Step 860 in method 800, expelling the implant from the microcatheter,can include sub steps as illustrated in FIG. 10. In sub step 862, thebraided portion can be expelled from the microcatheter. In sub step 864,the braided portion can be expanded to form a sack shape based on thespherical predetermined shape. In sub step 866, the embolic portion canbe expelled from the microcatheter. In sub step 868, the embolic portioncan be coiled within the sack shape of the braided portion.

The descriptions contained herein are examples of embodiments of theinvention and are not intended to limit the scope of the invention. Asdescribed herein, the invention contemplates many variations andmodifications of an implant, system, or method that can be used toocclude and fill an aneurysm. Variations can include but are not limitedto combining elements of various embodiments, utilizing alternativegeometries of elements and components described herein, utilizingalternative materials for each component or element (e.g. radiopaquematerials, memory shape materials, etc.), utilizing additionalcomponents including components to deliver the implant to a treatmentsite, position the implant at a treatment site, retract the implant,and/or eject a portion of the implant from a catheter, utilizingadditional component to perform functions describe herein, and utilizingadditional components to perform functions not described herein, forexample. These modifications would be apparent to those having ordinaryskill in the art to which this invention relates and are intended to bewithin the scope of the claims which follow.

1. An implant comprising: an expandable braided sack portion comprisinga free open end; an elongated looping portion joined to the expandablebraided sack portion; and a detachment feature joined to the elongatedlooping portion and detachably attached to a delivery system, whereinthe implant is movable from a delivery configuration sized to traversethrough a lumen of a catheter of the delivery system to an implantedconfiguration sized to secure within an aneurysm, wherein in thedelivery configuration, the expandable braided sack portion extends froma distal end of the implant, the elongated looping portion extendsproximally from the expandable braided sack portion, and the detachmentfeature is positioned approximate a proximal end of the implant, whereinin the delivery configuration, the expandable braided sack portion isunattached to the delivery system, wherein in the implantedconfiguration, the expandable braided sack portion is sized to contact amajority of an interior wall of the aneurysm, is sized to contain theelongated looping portion, and is sized to occlude at least a portion ofa neck of the aneurysm, wherein in the implanted configuration, the freeopen end is positioned to be placed approximate the neck, and wherein inthe implanted configuration, the elongated looping portion is sized towind within the expandable braided sack portion.
 2. The implant of claim1, wherein, in the delivery configuration, the implant comprises a foldapproximate the distal end of the implant, the expandable braided sackportion encompasses at least a portion of the elongated looping portion,and the free open end encircles the elongated looping portion.
 3. Theimplant of claim 1, wherein, in the delivery configuration, the freeopen end is positioned at the distal end of the implant.
 4. The implantof claim 1, wherein, in the implanted configuration, a fold defining aboundary between the elongated looping portion and the expandablebraided sack portion is positioned to be implanted approximate a distalsurface of the interior aneurysm wall.
 5. The implant of claim 1,wherein the elongated looping portion and the expandable braided sackportion are portions of a contiguous tubular braid.
 6. The implant ofclaim 5, wherein, in the implanted configuration, the elongated loopingportion comprises a substantially uniform circumference along a majorityof its length, the length measurable from the detachment feature to afold defining a boundary between the elongated looping portion and theexpandable braided sack portion.
 7. The implant of claim 1, wherein theelongated looping portion comprises an embolic coil, and wherein theexpandable braided sack portion comprises a tubular braid.
 8. Theimplant of claim 1, wherein the implant consists of the expandablebraided sack portion, the elongated looping portion, and the detachmentfeature.
 9. The implant of claim 1, wherein the detachment featureremains attached to the delivery system after detachment from theimplant.
 10. An implant comprising: an expandable braided sack portioncomprising a free open end; an embolic coil joined to the expandablebraided sack portion by a connecting band; and a detachment featurejoined to the embolic coil and detachably attached to a delivery system,wherein the implant is movable from a delivery configuration sized totraverse through a lumen of a catheter of the delivery system to animplanted configuration sized to secure within an aneurysm, wherein inthe delivery configuration, the expandable braided sack portion extendsfrom a distal end of the implant, the embolic coil extends proximallyfrom the expandable braided sack portion, and the detachment feature ispositioned approximate a proximal end of the implant, wherein in thedelivery configuration, the expandable braided sack portion isunattached to the delivery system, wherein in the implantedconfiguration, the expandable braided sack portion is sized to contact amajority of an interior wall of the aneurysm, is sized to contain theembolic coil, and is sized to occlude at least a portion of a neck ofthe aneurysm, wherein in the implanted configuration, the free open endis positioned to be placed approximate the neck, and wherein in theimplanted configuration, the embolic coil is sized to fit within theexpandable braided sack portion.
 11. The implant of claim 10, wherein,in the delivery configuration, the implant comprises a fold approximatethe distal end of the implant and a fold approximate the connectingband, the expandable braided sack portion encompasses at least a portionof the embolic coil, and the free open end encircles the embolic coil.12. The implant of claim 10, wherein, in the delivery configuration, thefree open end is positioned at the distal end of the implant.
 13. Theimplant of claim 10, wherein, in the implanted configuration, the foldapproximate the distal end of the implant is positioned to be implantedapproximate a distal surface of the interior aneurysm wall.
 14. Theimplant of claim 10, wherein the implant consists of the expandablebraided sack portion, the embolic coil, the connecting band, and thedetachment feature.
 15. The implant of claim 10, wherein the detachmentfeature remains attached to the delivery system after detachment fromthe implant.
 16. An implant comprising: an expandable braided sackportion comprising a free open end; an elongated looping portion joinedto the expandable braided sack portion; and a detachment feature joinedto the elongated looping portion and detachably attached to a deliverysystem, wherein the implant is movable from a delivery configurationsized to traverse through a lumen of a catheter of the delivery systemto an implanted configuration sized to secure within an aneurysm,wherein in the delivery configuration, the expandable braided sackportion extends from a distal end of the implant, the elongated loopingportion extends proximally from the expandable braided sack portion, andthe detachment feature is positioned approximate a proximal end of theimplant, wherein in the delivery configuration, the expandable braidedsack portion is unattached to the delivery system, wherein in theimplanted configuration, the expandable braided sack portion is sized tocontact a majority of an interior wall of the aneurysm, is sized tocontain the elongated looping portion, and is sized to occlude at leasta portion of a neck of the aneurysm, wherein in the implantedconfiguration, the free open end is positioned to be placed approximatethe neck, wherein in the implanted configuration, the elongated loopingportion is sized to wind within the expandable braided sack portion, andwherein in the implanted configuration, the expandable braided portionis inverted.
 17. The implant of claim 16, wherein, in the deliveryconfiguration, the implant comprises a fold separating the expandablebraided sack portion and the elongated looping portion.
 18. The implantof claim 17, wherein in the implanted configuration, the fold ispositioned near a distal surface of the aneurysm wall.
 19. The implantof claim 16, wherein the elongated looping portion and the expandablebraided sack portion are portions of a contiguous tubular braid.
 20. Theimplant of claim 16, wherein the elongated looping portion comprises anembolic coil, and wherein the expandable braided sack portion comprisesa tubular braid.